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Has Legalizing Voluntary Euthanasia in Belgium and Holland Created a "Slippery Slope" to Involuntary Euthanasia?

PRO (yes)

CON (no)

Gregory Koukl, Founder and President of Stand to Reason, noted in his Stand to Reason radio show (KBRT, AM 740 in Los Angeles) commentary titled "Euthanasia, Rights & Metaphysics" on the Stand to Reason website (accessed Oct. 9, 2009):

"Now in Holland, twenty years later, twenty years of de facto, legalized euthanasia, where doctors administer it, nearly twenty per cent of the deaths of that country every single year, 19.4% specifically, are a result of euthanasia. One in five people in Holland are euthanized...

11.3%, more than one in ten, of the total number of deaths in that country, every single year (14,691 according to the Dutch government...) are cases of involuntary euthanasia. What's involuntary euthanasia? That's when the patient says, 'I don't want to die,' and the doctor says, 'you're dead,' zap...

Your life is valuable if it makes a contribution. It is not making a contribution, so you are out of here. That's not just a slippery slope fallacy. That's not the old domino scare tactic. It's already happening in Holland and it started just this way. That's why when you make this kind of decision you better do your metaphysical thinking first. Instead of having your metaphysical conclusions that you made unwittingly gobble you up in the end."

Eugene Volokh, JD, Gary T. Schwartz Professor of Law at the University of California at Los Angeles, stated in a Feb. 2003 Harvard Law Review article titled "The Mechanisms of the Slippery Slope":

"[A] sort of equality-based slippage has indeed happened in the Netherlands.

Dutch courts began by declining to punish doctors who assist the suicides of the terminally ill. They then extended this to those who are subject to 'unbearable suffering,' without any requirement that they be terminally ill.

They then extended this to a person who was in seemingly irremediable mental pain, caused by chronic depression, alcohol abuse, and drug abuse, on the theory that the suffering of the mentally ill is 'experienced as unbearable' by them, presumably comparably to how the physically ill experience physical suffering.

Dutch courts then extended this to a 50-year-old woman who was in seemingly irremediable mental pain caused by the death of her two sons, again on the theory that '[h]er suffering was intolerable to her.'"

Wesley Smith, JD, Senior Fellow in Human Rights and Bioethics at the Discovery Institute, stated in his May 25, 2006 testimony before the US Senate Judiciary Subcommittee on the Constitution, Civil Rights, & Property Rights:

"First, the slippery slope is very real. As Dr. [K.F.] Gunning put it, the Dutch have proved that once killing is accepted as a solution for one problem, tomorrow it will be seen as the solution for hundreds of problems. Once we accept the killing of terminally ill patients, as did the Dutch, we will invariably, over time, accept the killing of chronically ill patients, depressed patients, and ultimately perhaps, even children...

[T]he euthanasia virus is catching. A 2000 report found that 10 percent of Belgian deaths appear to result from euthanasia ["End-of-Life Decisions in Medical Practice in Flanders, Belgium: A Nationwide Survey," The Lancet, Nov. 25, 2000]. With Belgian doctors clearly eager to follow the lead of their Dutch neighbor, Belgium formally legalized euthanasia in 2002. Notably, the first Belgian case, the killing of a man with multiple sclerosis, violated the guidelines; and just as occurs routinely in the Netherlands, the doctor involved faced no consequences. Now Belgium is set to legalize euthanasia for children. Indeed, Belgian doctors in Flanders have been found to commit infanticide in about the same numbers as their Dutch counterparts."

May 25, 2006

Gonzalo Miranda, ThD, founder and former Dean of the School of Bioethics at Regina Apostolorum Pontifical University in Rome, stated in a Sep. 6, 2004 interview titled "Slippery Slope of Euthanasia for Children," published on the website of ZENIT, a non-profit international news agency:

"This measure [Groningen Protocol], which allows the application of euthanasia to all the born, demonstrates that the famous 'slippery slope' theory was correct.

Once a principle is established according to which a human being can be killed because he suffers, then logically it extends to all those suffering. If a human being is killed who requests it, it can be applied to all human beings who request it, even if they are not suffering.

When discussion on euthanasia began in the Netherlands and in other countries, many pointed out the danger of sliding toward the worst, and the defenders of the measure said that it would not happen... Despite the opposition of public opinion, just two years after that law, we are already facing its application to all the born, without any kind of informed consent by the interested party."

David N. O'Steen, PhD, Executive Director of the National Right to Life Committee, stated in a Nov. 28, 2000 press release titled "Legalizing Euthanasia in Holland and the 'Slippery Slope'":

"The fact that euthanasia is being re-regulated in the Netherlands does not mean that it is going to be slowed...

Once you open the door to justify killing in some cases, the practice inevitably grows and grows as it has in Holland where there are now many patients killed who have never requested euthanasia at all."

Agnes van der Heide, MD, PhD, Senior Researcher in the Department of Public Health at Erasmus University, in a May 10, 2007 New England Journal of Medicine: article titled "End-of-Life Practices in the Netherlands under the Euthanasia Act," stated:

"In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001.

In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.

Conclusions: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation."

Penney Lewis, LLM, Reader in Law at the School of Law and Centre of Medical Ethics at Kings College, stated in a Spring 2007 Journal of Law, Medicine & Ethics: article titled "The Empirical Slippery Slope from Voluntary to Non-Voluntary Euthanasia":

"Most critics rely predominantly on Dutch evidence of cases of 'termination of life without an explicit request' as evidence for the slide from voluntary euthanasia to non-voluntary euthanasia. According to the three national surveys of 'medical behaviour which shortens life' in the Netherlands, the cases in the 'termination of life without an explicit request' category represent less than one percent of all deaths…

The critics who rely on this slippery slope argument often omit two important elements, thereby using flawed logic. First, the argument is only effective against legalization if it is legalization which causes the slippery slope. Second, it is only effective if it is used comparatively, to show that the slope is more slippery in the Netherlands than it is in jurisdictions which have not legalized assisted suicide or euthanasia. Since these questions have not been addressed by critics, little attention has been paid to available evidence on causation and comparability…

There is no evidence demonstrating that the Netherlands has a greater rate of non-voluntary or involuntary euthanasia than other Western countries. Indeed, there is a significant amount of evidence demonstrating the prevalence of both voluntary and nonvoluntary active euthanasia in various jurisdictions in which euthanasia has not been legalized, looking at criminal prosecutions, admissions by doctors and anonymous surveys of medical professionals."

"Neither Oregon nor the Netherlands appear to have started down a slippery slope. ... Also, physicians have become better equipped to offer a wide variety of palliative care, leading them to become more effective at it and very rarely having to resort to assisted death...

The passing of the law was a formalization of a practice that the Netherlands freely admitted occurred on a less-than-rare basis."

Derek Humphry, President of the Euthanasia & Guidance Organization (ERGO), wrote in an article titled "The Case for Assisted Suicide and Active Voluntary Euthanasia" on near-death.com (last updated on June 11, 2006):

"In the Netherlands we have a living laboratory in which the euthanasia experiment in being conducted, and it is claimed that active non-voluntary and involuntary euthanasia are openly practiced there, exactly as predicted by the slippery slope argument. But the claim of the open and common practice of involuntary euthanasia has been often repeated but has never been substantiated, and indeed has been repeatedly challenged."

Robert Young, PhD, Reader in the School of Communication, Arts, and Critical Enquiry at La Trobe University, wrote in an Aug. 27, 2008 article titled "Voluntary Euthanasia" on the Stanford Encyclopedia of Philosophy website:

"[S]ince there is nothing arbitrary about distinguishing voluntary euthanasia from non-voluntary euthanasia (because the line between them is based on clear principles), there can be no substance to the charge that only by arbitrarily drawing a line between them could non-voluntary euthanasia be avoided once voluntary euthanasia was legalized...

[The Netherlands'] legalization of voluntary euthanasia has not increased the incidence of non-voluntary euthanasia. Indeed, such studies as have been published about what happens in other countries, like Australia, where no legal protection is in place, suggest that the pattern in The Netherlands and elsewhere is quite similar. Some have argued, further, that there may be more danger of the line between voluntary and non-voluntary euthanasia being blurred if euthanasia is practised in the absence of legal recognition, since there will be no transparency or monitoring...

None of this is to suggest that there is no need to put in place safeguards against potential abuse of legally protected voluntary euthanasia...

[I]f the arguments given above are sound (and the Dutch experience, along with the more limited experience in the State of Oregon and in Belgium, is not only the best evidence we have that they are sound, but the only relevant evidence), that does not seem very likely."